Super-Charge a Cosmetic Surgeon Search

"A lovely woman searches for a plastic surgeon over the phone"
“….and is the doctor board-certified?”

Say, you’re looking in Beverly Hills and the surrounding L.A. area for a cosmetic surgeon to do rhinoplasty, face and neck lift, or some other procedure. You want the procedure done once and as well as human hands can do.

          (See some rhinoplasty before & after pictures.)

Given that cosmetic surgeons in Beverly Hills and L.A.  are as thick of fleas, you have hundreds of choices, all with seemingly excellent patient reviews and before and after surgery pictures.

          (Really! What cosmetic surgeon would post bad cosmetic surgery before and after photos?)

You can save some shoe leather, minimize traffic woe and wasted hours of time with some short phone calls. Plus, cosmetic surgeon  first consultation fees range from $100 to $200.

Use your computer to read patient review letters on surgeons’ websites, at Yelp, Face Book, and other review sites. Then, draw up a list of likely cosmetic surgeons who could achieve your rejuvenation goals.

Next, use your phone for some short screening calls. Make a “call sheet” with the doctors’ names, address, website URL, phone and room to jot some notes.

Your purpose: many items you pay for in a first consultation can be obtained over the phone for free.

1st question: “Is the doctor board-certified?” If yes, which board? Jot it down. (Some cosmetic surgery boards are not recognized in medicine.)

2nd query: Did the doctor serve a cosmetic fellowship?

          (Learn more about a cosmetic plastic surgery fellowship.)

3rd question; “Is the practice only for cosmetic surgery?

At this point, if you don’t have two “yes” answers, call the next cosmetic surgeon on the list, repeat the above, plus:

1st question: “What five procedures does the doctor do most?” If your desired surgery is not on the list, hang up.

2nd question: if your procedure of choice IS among the most performed: “Where does the doctor do his surgeries? In the office? Outpatient surgery center? Hospital?” (Circle the response.)

3rd query: “Is that facility licensed by the state, by Medicare or accredited by JCAHO, AAAASF or AAAHC? (Circle the answer.) If none of the above apply, you would be in danger in surgery. Go to the next cosmetic surgeon on the list.

(Read what JCAHO, and other cosmetic surgery certifying bodies do.)

When you find a cosmetic surgeon whose office answers all of the above correctly, THEN, make an appointment for an initial consultation.


Selfies: Proven to Drive Cosmetic Surgery

"A shocked woman looks at her facial features in a mirror"
No More Selfies!

For quite some time, smart phone users, cosmetic plastic surgeons, human behavior experts and others wondered aloud if the landslide of “selfies” (self-taken smart phone pictures) were driving people to cosmetic surgery providers.

Popular thinking was, smart phone photos are so numerous, sharp and clear, every detail – and flaw – shows.

And because those same pictures ended up on social media like:

  • Facebook
  • Instagram
  • Pinterest
  • You Tube
  • Snapchat

the Internet population was free to comment – and not always kindly.  But, hey, it’s all about sharing, right? Even if your eyebrows are sagging and your upper eyelids have fallen so far, you need to prop them open.

          (Look at some eyelid lift before & after pictures.)

The popular cosmetic surgery website,, also wondered about the influence of social media and if it could actually drive people to sign on with cosmetic plastic surgeons. is a champ of selfie sharing; only board-certified plastic surgeons can sign up so thousands send in photos of their worst features like noses with humps or nostrils so turned up, you can see inside their noses. And worse.

         (Look at some facial cosmetic surgery before & after photos.)

Plastic surgeons answer tons of questions on the website. Some readers then choose a plastic surgeon to contact about having cosmetic surgery.

Tom Seery, founder and CEO of RealSelf, organized a survey, asking 527 website visitors if social media sites ever influenced them to have cosmetic surgery.

About half said yes, social media has an impact; 15.37 percent quickly answered “yes” while 33.40 percent thought social media had “somewhat” of an impact and made them more aware of facial or bodily changes they wanted.

According to Seery, another driver of potential patients to cosmetic plastic surgeons is that many readers are “highly influenced” by what others say on social media. An additional element: many website users trust the reviews and photos of their peers. Users also take to heart the information surgeons post to surgery questions.

          (See some permanent, non-surgical nose job before & after photos.)

Additionally, many plastic surgeons listed on report seeing more patients who use that website.

However, website users don’t jump the gun in a panic over a less-than-stellar selfie appearance. According to Seery, RealSelf statistics reveal that half of his website users research a cosmetic surgery treatment for more than a year.

         (Learn more about finding a good cosmetic plastic surgeon.)

One other bit of intelligence: again, according to Seery, one in four U.S. adult shares all his or her health experiences on social media.


Cosmetic Surgery Review Letters

"One keyboard has a 'review' button for writing about cosmetic surgeons"
More and more cosmetic surgery patients are hitting this button

You’ve found a cosmetic plastic surgeon online you like and read the website which lists the many qualifications of an excellent surgeon. Plus, the before and after pictures look good.

But before making that first appointment about, say, a nose job or face & neck lift, can you learn even  more about that cosmetic surgeon?

          (Look at some nose job before & after pictures.)

You bet! Read what other patients are reporting online about their experience with that cosmetic surgeon.

One great website,, lists only board-certified cosmetic surgeons. The website offers:

Online patient review letters are also at:

  • Yelp

(Look at some face & neck lift before & after pictures.)

Experts who help all types of doctors structure their offices and procedures to better satisfy patients (and help create glowing patient review letters), say about 84 percent of patients use online reviews to judge a physician or surgeon.

(See some patient review videos about a cosmetic surgeon.)

About 75 percent use online reviews to find a new cosmetic But don’t be surprised to see many glowing reports. Some people are suspicious that patient reviews are written by advertising people, but that’s almost always not the case.

Why? “Astroturfing,” – in house-authored, bogus patient reviews — is illegal, overseen by the Federal Trade Commission and punished by a $16,000 per day fine for each day a bogus letter appears.

About six percent of patients write poison pen review letters online.

To help judge the veracity of online reviews, see if there is at least one critical — or slightly negative — letter in a mix of rave reviews. It’s difficult to satisfy 100 percent of the people 100 percent of the time.

But if you see every other or every fourth letter is negative, well, you’ve done your homework. Move on.

About two-thirds of patient review letter readers expect a surgeon response to complaint letters.

Statistics show about 13 percent write neutral reviews, about 50 percent pen very or somewhat positive feedback letters while one-third of survey respondents have never written a health care review letter.

If you read a negative review about a cosmetic surgeon, note if he responds politely and courteously, takes the letter writer seriously and thanks the patient for writing.

The smartest surgeons regard downbeat reviews as learning experiences, don’t respond immediately while emotions are high, talks about how to resolved the situation and isn’t defensive or critical.

Plus, one more thing: he asks the writer to remove the review.

Cosmetic Surgery & Medical Tattoos

"A woman with medical tattoo drives car"s
“Body Art:”hard to remove

Most cosmetic surgery practitioners are death on tattoos. “Body art” that was once cool on a 20-year-old is often embarrassing on a 35-year-old professional who finds him or herself using bandages to cover the “tats” before going in to the office.

Plus, it is a serious chore for the cosmetic plastic surgeon or dermatologist – plus some pain to the patient – to remove the tattoos.

But there’s an important exception: Medical tattoos.

Dutch researchers report that ugly scars from cancer surgery can use medical tattoos to help restore some of the skin’s natural look. Researchers queried 56 subjects who had medical tattooing at an Amsterdam hospital between 2007 and 2015. Three-quarters were women.

          (Look at some chemical wrinkle remover before & after pictures.)

Study leader Rick van de Langenberg, M.D. a Dutch ENT (Ear, Nose and Throat specialist) surgeon at Maastricht University organized the study of patients with head and neck medical tattoos covering scars. He found their scars looked better, while the subjectsthought less about the scars and were less stressed overall.

          (See some face & neck lift before & after photos.)

Results?  Before the tattooing, the subjects rated the look of their scars an average 3.8 on a scale of 0 to 10. After the medical tattooing, they rated the appearance of the scars an average 7.8.

Additionally, Dr. Langenberg said all the subjects’ quality of life and patient satisfaction improved after tattooing.

In one case, a botched procedure took away the natural red color of a woman’s lower lip. Medical tattooing restored it. Another subject said she used to have a long, red scar down her neck. Medical tattoos removed most of the red color.

         (Look at some permanent, non-surgical nose jobs.)

Remarked Fred Fedok, M.D., new president of the of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS): “Medical tattoos have been actually been used in United States for many years.”

According to Dr. Fedok, medical tattooing can be used anywhere on the body where adding tattoo pigment helps the look of a scarred region. If the scarred area is too light, it can be made darker.  The actual color of the skin can be duplicated in many cases.

That is, with a caveat: most dermatologists and cosmetic plastic surgeons are not trained in the art of medical tattooing. Special training and experience are required. So some doctors keep a list of trained medical tattoo specialists on tap for patients who need it.

Just goes to show how today’s medicine is more highly specialized than ever.

Cosmetic Surgery for Under Eye Bagging

"A woman shows her face before and after eye bag surgery"
Lower blepharoplasty, before (left) and after

Under eye bagging is such a concern, consumers can find a literal ocean of creams, ointments, “special” preparations, serums and other products claiming to dissolve under eye bagging and dark circles. Result: nothing appears to work and, alas, others still see that person as haggard and tired.

Common blame goes to working too hard, staying up too late, worrying too much, lack of exercise, smoking and drinking, too much salt in the diet, and other bugbears.

Bogus but popular remedies include:

  • Cucumber slices
  • Tea bags
  • Preparation H

Actually, under eye bagging developed due to a weakening and bulging of normal fat that surrounds and protects the eyeballs. The passing years cause eye bags because the tissues around the eyes loose elasticity and strength. Result?

Redundant, dark skin on your cheeks, bagging and sagging upper eyelids.

Under eye darkness can be caused by tobacco use, other environmental factors and is worsened by thinning skin and prominent blood vessels.

           (Top 6 things to know before getting blepharoplasty.)

Blepharoplasty removes excess skin and fat that cause the eye bagging and for sagging upper eyelids falling down over the eyes. Both can be done at once.

(Hint: if your healthy vision is being limited because of sagging upper eyelids, health insurance may cover some costs.)

          (Learn more about cosmetic surgery & health insurance.)

Blepharoplasty is done in a number of ways, depending on the surgeon. Some surgeons performing under eye  blepharoplasty do the procedure through an incision on the inside of the lower eyelid. It’s known as the trans-conjunctival approach when patients do not need a lot of under eye skin removed.

               (See some blepharoplasty before & after pictures.)

Other surgeons make an incision just under the lower eyelashes (medically, the “sub-ciliary approach”) when patients do need some excess lid skin and fat removed. Generally, the lower lashes help conceal the light scar that forms after surgery.

Look for a cosmetic plastic surgeon who has many years of experience – and the blepharoplasty before and after pictures to demonstrate his or her skill – because removing too much skin and fat can result in a hollowed-out facial look.

Some surgeons use facial fillers like Restylane in select cases. Because we also lose cheek fat with age, the lower eyelid fat becomes easier to see and appears baggy. Replacing cheek fat with facial fillers smooths the hollow area from the eyelid to the cheek and diminishes the bagging.

Experts caution that advanced training is required for treating eye bagging with fillers which, alas, dissolve in a matter of months.

                (Read the after-surgery care for under eye bagging.)

Cosmetic Surgeons & Hair Loss Help

"A lovely woman kisses the top of a bald man's head"Fat (or “grafting”) transfer  in facial cosmetic surgery is still questionable and has not won over many cosmetic surgeons.  However, a recent topic by a plastic surgeon at The Meeting, 2016 Plastic Surgery in Los Angeles may show a new way for treating  hair loss and baldness in men and women.

Said Joel A. Aronowitz, MD, an L.A. plastic surgeon: “Hair restoration could be a huge opportunity for cosmetic plastic surgeons, but is being overlooked by most because hair loss is traditionally treated with medication or with grafts.”

The dream of fat grafting has always been taking fat from places in the body where you don’t want it and putting it where you do want it. But, alas, cosmetic surgeons have found fat grafting results are often uneven or unpredictable in facial cosmetic plastic surgery.

          (Read more about Plastic Surgery & Hair Loss.)

The scalp is the latest place where you may want fat injections to help grow hair. It’s being hinted at by a new, but small, FDA study with 70 hair-challenged patients (medically, alopecia) at four medical sites. Early results show the fat-injected heads have “significantly” improved, with a low morbidity for the injected fat.

The problem with fat injection heretofore is that the fat must find a blood supply to survive.

One other scalp fat injecting study was done on only eight patients in Europe. Researchers used the subjects own fat and separated out some cells known as stromal vascular fraction (SVF) which are a rich source of stem and other growth cells.

     (Take your pick of before & after cosmetic plastic surgery photos.)

Stem cells are known for developing into whatever type cells are needed by the body.

After six months’ treatment, researchers did a hair measurement known as a TricoScan, a computer-based way to read hair density and what’s happening with patients’ hair roots.

Results? The average improvement was a 14 percent increase in hair count, compared to the start of the study. That amounted to 28 hairs. Six months later, the average increase was 34 percent.

Fat grafting is a promising alternative to hair grafts and medication for male and female hair restoration,” said Dr. Aronowitz.

According to Dr. Aronowitz, the results of the U.S. study will be released by early to mid-2017.

          (Read more about what we observe overall about fat grafting.)

Top 6 Facial Filler Myths

"An extreme close up shows a doctor placing a wrinkle remover into a woman's forehead"
Zapping “The 11’s”
  • Myth:   All  facial fillers and wrinkle removers are good, but various fillers do different things; what’s appropriate for one condition – like Botox or Dysport for crow’s feet – may not be the right for, say, lip fillers. Before your appointment, read up on which facial fillers are appropriate for which areas.
  •   Myth: Any cosmetic plastic surgeon can put fillers under the eyes. Facial fillers can certainly correct depressions under the eyes, but you need a plastic surgeon who has done the procedure for years. Why? Fillers in the wrong place around the eyes can be risky and cause very serious complications.
  •      Myth: Getting facial fillers is painful. Imagine lip injections! Cosmetic surgeons know all about pain control and use it liberally. Topical (spread on your skin) numbing agents are plentiful and make the syringe work go smoothly with no discomfort. In some sensitive locations like the lips, your doctor may add on a dental block too. Another reason not to get apprehensive: most hyaluronic injectables contain lidocaine, a powerful pain killer.

(For a weathered, aged, wrinkled face consider chemical wrinkle remover.)

  • Myth: You’ll become addicted. No addictive agent is used, so your face can’t cause addiction. What actually causes that rumor: you are very likely to love the look of your face so you’ll go back continually. Perhaps. But hyaluronic acid facial fillers are made to last between six months and two years, depending on what’s used and where. Hyaluronic acid is slowly absorbed by the body, but may leave behind some new collagen growth. (Collagen is the main structural protein found in connective tissue; so, the more, the better.)
  • Myth: Filler injections are easy for others to see. Make sure your doctor has injected fillers for several years and does so weekly. Actually, the only fillers others notice are overdone or misplaced. Board-certified dermatologists, facial plastic surgeons or cosmetic surgeons with years of experience can do the job.

          (Learn about injection rhinoplasty, a non-surgical nose job. Plus, see some injection rhinoplasty before and after pictures.)

  • Look younger forever with a permanent filler! Not quite. Use all the known permanent facial fillers, but your face will still continue to age. As we get older, facial bone under goes a very gradual decline while soft tissues lose volume. A permanent filler would cause an unnatural look and maybe even be in the wrong position ten years after the procedure.


Plastic Surgeons & Problem Sweating

"A woman turns to Botox after sweating too much"
Problem Sweat

Cosmetic plastic surgeons everywhere are accustomed to helping people with their self-image by making them look more refreshed, younger and wholesome.

But many – including some dermatologists who also perform cosmetic surgery — also treat patients with a strange condition known as hyperhidrosis. That condition allows the body’s cooling mechanism – perspiration – to run rampant, allowing sweat to flow like water from any of the:

  • Palms
  • Feet
  • Armpits
  • Upper body

Imagine being a salesman – famous for incessant glad handing – and having dripping wet palms.  Always. Or a female executive whose blouses are wet from the neckline to the waist.

       (Look at some before & after face and neck lift pictures.)

Hyperhidrosis has been in the news recently because patients with several types of the disorder were tested at two clinics – one apiece in Shanghai, China and Vancouver, British Columbia – for anxiety and depression. Turns out hyperhidrosis patients have much higher anxiety and depression levels and that may lead to a new treatment plan.

Currently, cosmetic plastic surgeons can use Botox for a treatment that is only one of three that medical insurance will cover. (The other two are migraine headaches and eyelid or facial spasms.) For patients who sweat profusely from the armpits, Botox is injected at several underarm locations just under the skin after numbing the area.

          (Read more about Botox and Dysport.)

According to the International Hyperhidrosis Society, Botox does its work by blocking the secretion of the bodily chemical that turns on the body’s sweat glands.

Testing has also shown excessive sweating of the hands, face and under womens’ breasts can be stifled via Botox resulting in an 82 to 87 percent decrease in sweating. Dryness usually lasts from four to 12 months and as long as 14 months.

        (See some permanent, non-surgical rhinoplasty pictures.)

Of course most physicians will try the simplest remedy first, in these cases, anti-perspiration products containing aluminum chloride.

At, the website for board-certified plastic surgeons, 93 percent of problem sweat patients said their Botox treatment was worth it.  Average cost: $1275.

          (Look at some revision nose job before & after pictures.)

MiraDry is yet another treatment, one that destroys sweat glands in the armpits via microwave energy. An experienced physician figures the microwave dosage needed and then the sweat glands are gone for good.

Only about two percent of our sweat glands are in the underarm so the body can still cool itself.

Global Plastic Surgery Statistics

"A woman's hand figures the numbers of cosmetic surgery operations"
Figuring the Numbers

Last year, it was Brazil, but now it’s the United States for which nation on earth has done the most cosmetic plastic surgeries during 2015.

So says the International Society of Aesthetic Plastic Surgery (ISAPS) which represents about 35,000 board-certified plastic surgeons worldwide and is just now releasing global plastic surgery statistics for 2015.

According to the ISAPS, the United States saw 1.2 million plastic surgeries and 2.6 million non-surgical procedures. Brazil came in second with 1.1 million non-surgical procedures and 1.2 million cosmetic plastic surgery procedures.

Next was Asian plastic surgery hot spot, South Korea followed by:

  • India
  • Mexico
  • Germany
  • Columbia
  • France
  • Italy

The annual survey showed Americans have 6,500 board certified plastic surgeons to draw on, compared to Brazil’s 5,500 and China’s 2800.

           (Read more about 2015 statistics for U.S- only plastic surgery)

The most popular procedure worldwide for men and women: Botox injections, followed by the various facial fillers containing Hyaluronic Acid, a natural substance that helps skin stay plump and hydrated.

Among woman – who had 18 million procedures or 85.5 percent of the total — breast augmentation was the most popular procedure and grew 10.4 percent over the previous year’s figures. The other top female procedures were:

  • Liposuction
  • Eyelid Surgery
  • Tummy Tuck
  • Rhinoplasty

For the guys, eyelid surgery and rhinoplasty lead the 2015 list of most commonly performed procedures.

          (See some rhinoplasty before and after pictures.)

Men also had eyelid surgery, liposuction, gynecomastia surgery, fat grafting and ear surgery, accounting for three million procedures or 14.4 percent of the total.

           (Look at some eyelid surgery before & after pictures.)

Because non-surgical procedures are growing like wildfire, more and more patients who wish to avoid nose job surgery (while saving 80 percent over the cost of surgery!) are taking advantage of a permanent, non-surgical nose job.

          (Look at some permanent, non-surgical nose job before & after pictures.)

If you think a non-surgical nose job may be right for you, you can get an exact preview how a corrected nose would look afterwards. First is numbing the nose, then injecting plain salt water, done in the office on your lunch break if you like.

The sterilized salt water dissolves in a couple of hours, but exactly duplicates how a permanent, non-surgical nose job will look when finished.

It’s known as the Kotler Salt Water Demo. Think of it as a test drive for your new, improved nose.

Awake Patients & Cosmetic Plastic Surgery

38041781 - doctors in scrubs and surgical masks scanning patient lying on hospital operating table
…….So my two kitties play together and unspool yarn and any rolls of toilette paper left out while my two grown kitties just worry about getting fed and you should see them play with the three kitties next door, but this dog…..

According to the American Journal of Surgery, a professional magazine for surgeons, more awake patients are being seen; those patients are having surgeries with only a local anesthetic to block sensations in the area being operated on.

Some surgeons like awake patients in surgery because the surgeon can ask the patient to move this way or that or answer questions during the operation.

But consider: if you are a surgeon with an awake patient who can hear all the sounds – and perhaps see some sights — around him in a typical operating room, it’s not too bad an idea to dismiss the phrase “oops!” from your vocabulary.

You might also want to find another way to ask surgical trainees to step over and take a gander at how your surgical work is going.

Studies have shown that awake patients want trainees and newbie surgeons nowhere near them.

Moreover, studies reveal that awake patients under the knife in operations – like biopsies, abortions, cataract surgery as well as some cosmetic plastic surgery procedures – tend to have shorter recovery times.

Awake patients for cosmetic surgeries often include:

Cosmetic plastic surgeons using local anesthesia usually also provide intravenous sedation medications to awake patients.

            (See some Chemical Wrinkle Remover before & after photos)

However, buyer beware: “awake” cosmetic surgery can also be an attempt at cutting corners by doing without an anesthesiologist. To cope, check thoroughly on your surgeon’s qualifications and surgical training.

For instance, Miami plastic surgeon Constantino Mendieta, M.D. avoids awake patients for buttocks and breast augmentation because he does not want the patient to move at a critical moment.

                   (Learn more about face & neck lift)

Alexander Langerman, M.D., Assistant professor of otolaryngology at Vanderbuilt University Medical Center in Nashville, Tennessee and team interviewed 23 surgeons in various specialties about operating on awake patients.

On the plus side, Dr. Langerman said most of the surgeons reported awake surgery was more efficient and satisfying overall. But downsides included talking about patients’ pain during surgery and the chance a patient would make a risky movement.  Patients generally are so put off by trainee surgeons, the group of surgeons said it was harder to teach surgical newcomers.

          (See some neck sculpture before & after pictures.)

So most surgeons in the study were less likely to allow beginning surgeons to take part in procedures. Surgeons reported trying to make things more comfortable for patients on the operating table by playing music and limiting others from entering and leaving the room.

Some surgeons offered alert patients sedatives to help them relax or fall asleep.

          (Look at some permanent, non-surgical nose before & after photos.)

Rhinoplasty Surgeon Beverly Hills